Ulinastatin- and thymosin α1-based immunomodulatory strategy for sepsis: A meta-analysis

Objective: This meta-analysis was performed to evaluate the efficacy of ulinastatin (Tin) and thymosin alpha 1 (T alpha 1) based immunomodulatory strategy in sepsis patients. Methods: A systematic search was made of MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases. Randomized clinical trials on treatment of sepsis with the combination of ulinastatin and Tal, compared with placebo, were reviewed. Studies were pooled to relative risk (RR) and weighted mean differences (WMD), with 95% confidence interval (CI). Results: Six trials (enrolling 915 participants) met the inclusion criteria. Compared with placebo, the combination of ulinastatin and T alpha 1 presented significant effects on 28-day all-cause mortality (RR 0.67; 95% Cl 0.57 to 0.80), 90-day all-cause mortality (RR 0.75; 95% Cl 0.61 to 0.93), TNF-alpha (WMD -73.86 ng/L; 95% CI -91.00 to -56.73 ng/L), IL-6 (WMD -55.04 ng/L; 95% Cl -61.22 to -48.85 ng/L), and duration of mechanical ventilation (WMD -226 days; 95% Cl -2.79 to -1.73 days). Conclusions: Immunomodulatory therapy that combines ulinastatin and Tal significantly improves all-cause mortality, inflammatory mediators and duration of mechanical ventilation in subjects with sepsis. (C) 2015 Elsevier B.V. All rights reserved.